Unexpected early tumor recurrence in patients with hepatitis C virus-related hepatocellular carcinoma undergoing interferon-free therapy: a note of caution
Reig M, et al .
J Hepatol. 2016 Oct;65(4):719-26.
Abstract:
Background and aims: The success of direct acting antivirals against hepatitis C is a major breakthrough in Hepatology. Until now, however, there are very few data on the effect of HCV eradication in patients who have already developed hepatocellular carcinoma.
Methods:
The study included patients with HCV infection and prior history of treated hepatocelullar carcinoma who achieved complete response and lacked ‘non-characterized nodules' at the time they underwent anti-HCV treatment with all-oral direct acting antivirals in 4 hospitals. Patients receiving interferon as part of the antiviral regimen were excluded. The baseline characteristics, laboratory and radiologic tumor response were registered in all patients before starting antiviral therapy and during the follow-up according to the clinical practice policy.
Between 2014 and 2015, 103 patients with prior hepatocellular carcinoma received DAA, 58 of them met the inclusion criteria. After a median follow-up of 5.7 months, 3 patients died and 16 developed radiologic tumor recurrence (27.6%). The pattern of recurrence was: intrahepatic growth (3 patients), new intrahepatic lesion (1 nodule in 5 patients, up to 3 nodules less or equal to 3 cm in 4 cases and multifocal in one patient) and infiltrative ill-defined hepatocellular carcinoma and/or extra-hepatic lesions in 3 patients. Conclusions: Our data show an unexpected high rate and pattern of tumor recurrence coinciding with HCV clearance and, though based in a very small cohort of patients, should be taken as a note of caution and prime a large scale assessment that exceeds the individual investigators capacity.
Expert's Commentary
«This study, a multicenter trial from Spain, found an unexpected early tumor recurrence in patients with hepatitis C virus–related hepatocellular carcinoma undergoing interferon-free therapy. Reig et al. included 58 patients with HCV infection and prior history of treated hepatocelullar carcinoma who achieved complete response and lacked ‘non-characterized nodules' at the time they underwent anti-HCV treatment with all-oral DAAs. After a median follow-up of 5.7 months, 16 out of 58 patients developed radiologic tumor recurrence (27.6%). The pattern of recurrence was: intrahepatic growth (3 patients), new intrahepatic lesion (1 nodule in 5 patients, up to 3 nodules less or equal to 3 cm in 4 cases and multifocal in one patient) and infiltrative ill-defined hepatocellular carcinoma and/or extra-hepatic lesions in 3 patients. The study authors hypothesize that the recurrences could be a result of a weakened immune system following DAA therapy. This result should be taken as a note of caution at least until data from further large-scale assessments are available. »
Pr Maria Butti,
Hospital General Universitari Valle Hebron, Barcelona
